Aims Patients with severe obesity are predisposed to left ventricular (LV) hypertrophy, increased myocardial oxygen demand, and impaired myocardial mechanics. Bariatric surgery leads to rapid weight loss and improves cardiovascular risk profile. The present prospective study assesses whether LV wall mechanics improve 1 year after bariatric surgery. Methods and results Ninety-four severely obese patients [43 ± 10 years, 71% women, body mass index (BMI) 41.8 ± 4.9 kg/m2, 57% with hypertension] underwent echocardiography before, 6 months and 1 year after gastric bypass surgery in the FatWest (Bariatric Surgery on the West Coast of Norway) study. We assessed LV mechanics by midwall shortening (MWS) and global longitudinal strain (GLS), LV power/mass as 0.222 × cardiac output × mean blood pressure (BP)/LV mass, and myocardial oxygen demand as the LV mass-wall stress-heart rate product. Surgery induced a significant reduction in BMI, heart rate, and BP (P < 0.001). Prevalence of LV hypertrophy fell from 35% to 19% 1 year after surgery (P < 0.001). The absolute value of GLS improved by—4.6% (i.e. 29% increase in GLS) while LV ejection fraction, MWS, and LV power/mass remained unchanged. In multivariate regression analyses, 1 year improvement in GLS was predicted by lower preoperative GLS, larger mean BP, and BMI reduction (all P < 0.05). Low 1-year MWS was associated with female sex, preoperative hypertension, and higher 1-year LV relative wall thickness and myocardial oxygen demand (all P < 0.001). Conclusion In severely obese patients, LV longitudinal function is largely recovered one year after bariatric surgery due to reduced afterload. LV midwall mechanics does not improve, particularly in women and patients with persistent LV geometric abnormalities. ClinicalTrials.gov identifier NCT01533142, 15 February 2012.
Background: Aortic valve sclerosis (AVS), mitral valve sclerosis (MVS), remodeling of major arteries, and increased pericardial fat are associated with subclinical atherosclerosis. We assessed these markers of atherosclerosis in severely obese patients before and 1 year after bariatric surgery. Methods: Eighty-seven severely obese patients (43 ± 10 years, preoperative body mass index [BMI] 41.8 ± 5 kg/m2) underwent echocardiography before and 1 year after Roux-en-Y bypass surgery in the FatWest (Bariatric Surgery on the West Coast of Norway) study. We measured the end-diastolic aortic wall thickness (AWT), pericardial fat thickness at the right ventricular free wall, and AVS/MVS based on combined aortic leaflet thickness and hyperechoic valve lesions. Results: Postoperatively, patients experienced a reduction of 12.9 ± 3.9 kg/m2 in BMI, 0.5 ± 1.9 mm in AWT, 2.6 ± 2.3 mm in pericardial fat, and 45%/53% in AVS/MVS (p < 0.05). In multivariate regression analyses with adjustment for clinical and hemodynamic variables, less pericardial fat reduction was associated with male sex and higher 1-year blood pressure and BMI, and less AWT-reduction with higher age and 1-year BMI (p < 0.05). Persistent AVS and MVS were related to higher 1-year BMI and more advanced valve sclerosis preoperatively (p < 0.05). Conclusions: Markers of subclinical atherosclerosis decreases significantly 1 year after bariatric surgery, particularly in younger patients that achieve a BMI < 28 kg/m2.
Introduction: Patients with severe obesity are predisposed to left ventricular (LV) myocardial dysfunction and increased myocardial oxygen (O 2 ) demand despite preserved ejection fraction (EF). Hypothesis: To test whether electrocardiography (ECG) may be used to identify patients with severe obesity that have myocardial dysfunction despite normal EF by echocardiography. Methods: In the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study, 116 severely obese patients (41±11 years, 75% women, body mass index [BMI] 41.7±4.6 kg/m 2 , 57% with hypertension, EF 61±5%) underwent 12-lead ECG and echocardiography before a Roux-en-Y gastric bypass surgery. Low LV mechanics was defined as global longitudinal strain (GLS) below the median, and high myocardial O 2 demand as LV mass-wall stress-heart rate product above the median value. ECG markers of atrial (P axis and duration) and ventricular (QRS axis and duration, T axis, QRS-T angle, time to intrinsicoid deflection (ID), and corrected QT (QTc)) de- and repolarization were analyzed. Results: Median GLS was -15.5%, and median myocardial O 2 demand 1.47 x106 g kdyne/cm 2 bpm. Patients with low GLS had longer QRS, time to ID and QTc duration, while those with high myocardial O 2 demand had increased P axis and duration (all p<0.05). In multivariate regression analyses, longer QTc was associated with lower GLS (R 2 0.24) and increased P axis with higher myocardial O 2 demand (R 2 0.21) independent of age, gender, BMI and hypertension (all p<0.05). A QTc >435ms and P axis >42° had 70% specificity in detecting low GLS and high myocardial O 2 demand (Figure). Conclusion: In severely obese patients, ECG measures of atrial activation and delayed ventricular repolarization were independently associated with low LV myocardial function and high myocardial O 2 demand. ECG screening before bariatric surgery may identify patients in whom advanced echocardiography is warranted.
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